At present, global migration is higher than it has ever been. As a result, healthcare providers find themselves with patients from culturally diverse backgrounds. Health and illness are now beginning to be understood, not just in terms of biological factors, but also in terms of the psychological and social contexts that patients come from. This highlights the need to consider cultural backgrounds in healthcare and move away from simplistic understandings of illness.
Cross-cultural psychology explores the differences and similarities in factors like behaviour, cognition, and emotions across cultures. While it is not an independent area of practice, it provides a lens through which one can critically analyse existing frameworks and theories. In this piece, I attempt to apply a cross-cultural lens to healthcare by exploring the differences in people’s understandings of health and wellness and the subsequent need for culturally sensitive care.
Health beliefs refer to individuals’ beliefs about their state of health or wellness. These beliefs influence their health choices, as well as their decision to access healthcare services. However, individuals are situated within broader cultures and thus, cultural definitions of health, accepted norms, and value systems play an important role in determining individual health beliefs. For instance, there is evidence to suggest that different societies attribute health outcomes to different factors- African Americans attribute outcomes to external, spiritual factors like God and destiny, while Latino populations view them as being a reward or punishment for good or bad behaviour respectively. On the other hand, in the West, illness tends to be attributed to personal factors, like lifestyle, or natural ones, like pollution.
Cultures also evaluate health in different ways. Thus, the point at which the line is drawn between illness and health can vary greatly. For instance, in some cultures, children suffering from worms are considered common and a result of consuming excess sweet. However, the Western model provides a completely different explanation of worms occurring due to food contamination through soil. Similarly, some parts of India believe that pregnant women must consume less food to accommodate the growth of the foetus, while Western beliefs are very different.
In light of these cross-cultural differences in health beliefs and behaviours, it is essential for healthcare and medical professionals to be clinically and culturally competent. It has been found that 83% of accurate initial diagnoses involve taking an in-depth medical history of the patient at the very outset. Thus, it is important to consider an individual’s background along with presenting concerns and symptoms. Further, training medical professions to understand cultural difference can help eliminate possible prejudice and discrimination on the basis of race, caste and gender.
The medium of instruction and conversation also plays a crucial role in healthcare provision and treatment adherence. Language barriers could create major gaps in understanding between the patient and the doctor, leading to a poor patient-provider relationship and non-adherence to medication and treatment. Research has found higher patient satisfaction among minority group members who have a common background or language with their doctor. As mentioned earlier, culture also influences health literacy (i.e., subjective understandings of health and illnesses). Cultural differences in health literacy between the patient and the doctor can lead to poor communication in terms of explanation of symptoms and comprehension of the problem at hand. Additionally, a language barrier could also stand in the way of the patient receiving quality information regarding health, because television advertisements, medical pamphlets and online health advice would be in their non-native language. A study conducted in the UK found that knowledge of diabetes and related information increased among Pakistani immigrants when information was provided in the form of images on flashcards rather than on pamphlets printed in English.
With increasing migration and an increasingly diversified client base, an understanding of cross-cultural differences in perceptions of, and beliefs about, health and health-related behaviours is crucial in healthcare services. The goal is thus to move towards healthcare that is culturally sensitive and aware. This means looking beyond cultural stereotypes to more relevant variables like ethnicity, health literacy, and socio-economic status that affect health beliefs and behaviour. This also highlights the shortcomings of a single universal model of health and the need for varied, culturally appropriate understandings of wellness and illness.
Arundhati Ail
